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Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - C <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> Douglas Vt�.c�e. <br /> a�na ld 6 t u i I <br /> OWNER 1 all TELEPHONE a <br /> CJl v <br /> d <br /> HOME ADDRESS <br /> O <br /> o <br /> EMERGENCY/FIRE NUMBER ROAD NAME jj( jj 5 flo <br /> a� <br /> ( p) �o� , k I , cQ l T39PJ �171 9' <br /> LEGAL DESCRIPTION see tax t <br /> rn o <br /> TYPE OF PERMIT(S):DWELLINGBUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ' <br /> Q <br /> n <br /> w' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION-) of = .—' <br /> N <br /> STRUCTURE/ADDITION USE: esm / e U <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc. e c <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. c, <br /> 0 w � <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) T n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 0 16,;b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m a <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OH WM)OF LAKE, Z <br /> STREAM OR RIVER. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- (� <br /> INGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> N i TIT- <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS I <br /> MUST BE SIGNED AND DATED BY THE OWNER. n o Dj 9J <br /> o Ql Rl 9) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE I i <br /> ISSUED. g I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c lal <br /> CONDITIONS OF PERMIT: i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT E� <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY a <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> M -0Arm 00 '9 <br /> 6. L <br /> a : m C w w o 5 3 <br /> 7. Z : !' : i 1 <br /> o : m <br /> =rn: � m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C' p <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of C C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information I am ; m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. n <br /> m : <br /> m : <br /> h : <br /> SIGN HERE <br /> (signature of owner or <br /> building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> H <br /> HWhHHw� <br /> N N <br /> 9" 9"99 PVt OkTPP <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 o <br />